J Trauma
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Induced hypothermia is used clinically to prevent ischemic injury during elective procedures. We present an animal model of asanguinous hypothermic (10 degrees C) circulatory arrest, induced through a left anterior lateral thoracotomy after exsanguinating uncontrolled hemorrhage. ⋯ Induction of hypothermic arrest through the chest after exsanguination is possible. The further development of this technique may provide an extended state of "suspended animation" to allow for repairs of hemorrhaging injuries in trauma patients who require emergency department thoracotomy.
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Toward the establishment of an injury surveillance system in Uganda, the first step was to initiate hospital-based trauma registries that generate relevant and timely data on the causes, severity, morbidity, mortality, and outcomes of injuries at Mulago and Kawolo hospitals. This would help establish injury patterns and priorities in these hospital populations. The registries are based on a minimal data set and a new injury severity instrument, the Kampala Trauma Score (KTS). The usefulness of the registry and the qualities of the KTS are presented. ⋯ A trauma registry and injury severity measurement are both possible and useful in sub-Saharan Africa. This minimal data set and the KTS are recommended for investigators with similar resource constraints.
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Randomized Controlled Trial Clinical Trial
Fluid resuscitation of patients with multiple injuries and severe closed head injury: experience with an aggressive fluid resuscitation strategy.
Despite increasing experimental and clinical evidence to the contrary, a dichotomy of management strategies of the patient with multiple injuries still exists, based on the presence or absence of traumatic brain injury. Many still advocate fluid restriction or small volume resuscitation if traumatic brain injury is present. ⋯ Fluid restriction is not necessary to achieve good results in the severely injured patient who also has a severe head injury.
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The sequelae of blunt injury to the carotid arteries are unusual, but pseudoaneurysms causing subsequent strokes are devastating. The utility of treatment of these pseudoaneurysms was examined. ⋯ Use of metallic endoprostheses is an effective method to treat this potentially devastating injury. However, longer follow-up and more patients studied are needed to further examine this promising treatment.
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Unplanned endotracheal extubation (UEE) is a common complication in medical intensive care units but very little data about UEE in surgical populations are available. Our hypothesis is that the surgical intensive care unit (SICU) population requires reintubation less frequently compared with the medical intensive care unit population. We prospectively gathered data on patients in a SICU in an attempt to identify the incidence of UEE and to study the need for reintubation after UEE. ⋯ A total of 85% of patients who self-extubate during the weaning process did not require reintubation in our study. Those who have an FiO2 >50%, a lower PaO2/FiO2 ratio, had UEE occur by accident, or were not being weaned when UEE occurred required reintubation more frequently. These data suggest that some of our SICU patients are intubated longer than necessary, which may translate into more ventilator related complications, longer ICU stays and increased cost.